Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?

Kurian, Ashwin A.; Gallagher, Sidhbh; Cheeyandira, Abhiman; Josloff, Robert

doi:10.1007/s10029-010-0649-0

Cited by 24 publications

(19 citation statements)

References 30 publications

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“…Another analysis of the literature on elective surgery of ventral and incisional hernias identified inconsistencies in reporting of peri- and postoperative variables and poor definition of variables ( 29 ). A further problem is the pooling of primary ventral hernias and incisional hernias in many studies, meta-analyses and systematic reviews ( 30 – 33 ). Several studies have demonstrated that there is a significant difference between the outcomes for primary abdominal wall hernias and incisional hernias, hence these hernia entities should not be pooled ( 30 – 33 ).…”

Section: Introductionmentioning

confidence: 99%

“…A further problem is the pooling of primary ventral hernias and incisional hernias in many studies, meta-analyses and systematic reviews ( 30 – 33 ). Several studies have demonstrated that there is a significant difference between the outcomes for primary abdominal wall hernias and incisional hernias, hence these hernia entities should not be pooled ( 30 – 33 ). Against that background the present review aims to identify which data are available on the sublay/retro-rectus operation to demonstrate that this is the best open technique for repair of only incisional hernia.…”

Section: Introductionmentioning

confidence: 99%

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What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Köckerling

Schug-Paß

Scheuerlein³

2018

Front. Surg.

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Introduction: There continues to be very little agreement among experts on the precise treatment strategy for incisional hernias. That is the conclusion drawn from the very limited scientific evidence available on the repair of incisional hernias. The present review now aims to critically assess the data available on the sublay/retro-rectus technique for repair of incisional hernia. Materials and Methods:A systematic search of the literature was performed in May 2018 using Medline, PubMed, and the Cochrane Library. This article is based on 77 publications.Results: The number of available RCTs that permit evaluation of the role of the sublay/retro-rectus technique in the repair of only incisional hernia is very small. The existing data suggest that the sublay/retro-rectus technique has disadvantages compared with the laparoscopic IPOM technique for repair of incisional hernia, but in that respect has advantages over all other open techniques. However, the few existing studies provide only a limited level of evidence for assessment purposes. Conclusion:Further RCTs based on a standardized technique are urgently needed for evaluation of the role of the sublay/retro-rectus incisional hernia repair technique.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Köckerling

Schug-Paß

Scheuerlein³

2018

Front. Surg.

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“…Retrospective population-based studies reported conflicting results [12][13][14][15][16][17][18]. Excellent results, when dealing with primary ventral hernias, have been published [19][20][21]. Laparoscopic approach could play a role in reducing perioperative morbidity and cardio-circulatory overload in elderly patients.…”

Section: Luis Sanchez Lapo Bencinimentioning

confidence: 96%

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

et al. 2015

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The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.

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“…The findings of three further systematic reviews and meta-analyses must be analyzed in a critical light with respect to the key question addressed here since they included studies with primary abdominal wall hernias and incisional hernias, i.e., mixed patient collectives, as well as the laparoscopic technique ( 38 – 40 ). Numerous studies have demonstrated that the outcomes for repair of primary abdominal wall hernias and incisional hernias differ highly significantly and therefore should not be combined ( 41 – 45 ). Moreover, the mesh position as underlay was not defined exactly.…”

Section: Resultsmentioning

confidence: 99%

Open Intraperitoneal Onlay Mesh (IPOM) Technique for Incisional Hernia Repair

Köckerling

Lammers

2018

Front. Surg.

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In an Expert Consensus Guided by Systematic Review the panel agreed that for open elective incisional hernia repair sublay mesh location is preferred, but open intraperitoneal onlay mesh (IPOM) may be useful in certain settings. Accordingly, the available literature on the open IPOM technique was searched and evaluated.Material and Methods: A systematic search of the available literature was performed in July 2018 using Medline, PubMed, and the Cochrane Library. Forty-five publications were identified as relevant for the key question.Results: Compared to laparoscopic IPOM, the open IPOM technique was associated with significantly higher postoperative complication rates and recurrence rates. For the open IPOM with a bridging situation the postoperative complication rate ranges between 3.3 and 72.0% with a mean value of 20.4% demonstrating high variance, as did the recurrence rate of between 0 and 61.0% with a mean value of 12.6%. Only on evaluation of the upward-deviating maximum values and registry data is a trend toward better outcomes for the sublay technique demonstrated. Through the use of a wide mesh overlap, avoidance of dissection in the abdominal wall and defect closure it appears possible to achieve better outcomes for the open IPOM technique.Conclusion: Compared to the laparoscopic technique, open IPOM is associated with significantly poorer outcomes. For the sublay technique the outcomes are quite similar and only tendentially worse. Further studies using an optimized open IPOM technique are urgently needed.

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Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?

Abstract: The LOP and LOS are longer after the laparoscopic repair of incisional than for primary ventral hernias. This disparity should be kept in mind when counseling patients and while designing trials investigating laparoscopic ventral hernia repairs (LVHRs).

Cited by 24 publications

References 30 publications

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference

Open Intraperitoneal Onlay Mesh (IPOM) Technique for Incisional Hernia Repair

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